Use of progressive glaucomatous optic disk change as the reference standard for evaluation of diagnostic tests in glaucoma

PURPOSE: Progressive change in optic disk appearance has been suggested as the best available reference standard for glaucoma diagnosis. We evaluated the accuracy of scanning laser polarimetry (SLP) with variable corneal compensation to discriminate patients with documented progressive optic disk change from healthy subjects. DESIGN: Observational case-control study. METHODS: Glaucoma patients with documented evidence of progressive optic disk change as assessed by stereoscopic photographs were selected. Healthy control subjects had normal visual fields and normal clinical examination. All subjects underwent imaging with the GDx VCC scanning laser polarimeter. Receiver-operating characteristic (ROC) curves, sensitivities at fixed specificities, and likelihood ratios were calculated. RESULTS: Sixty-five eyes were healthy control patients. Seventy,one eyes had progressive optic disk change, of which 41 (58%) had abnormal visual field tests closest to the imaging date (perimetric glaucomatous optic neuropathy [GON]), and 30 (42%) eyes had normal visual fields (preperimetric GON). The GDx VCC parameter nerve fiber indicator performed best for discrimination between perimetric GON and normal eyes (AUC = 0.94; sensitivity = 93% for specificity >= 80%) as well as for the discrimination between preperimetric GON and normal eyes (AUC = 0.89; sensitivity = 83% for specificity >= 80%). CONCLUSION: SLP differentiated patients with documented progressive optic disk change from normal sub, jects and detected abnormalities in patients with confirmed diagnosis of preperimetric GON, suggesting that it may be useful for early glaucoma diagnosis. We suggest that progressive optic disk change should be used in the evaluation of diagnostic accuracy of imaging instruments for glaucoma. (c) 2005 by Elsevier Inc. All rights reserved.